Tumescent anaesthesia

Abstract

Tumescent anaesthesia describes the practice of injecting a very dilute solution of local anaesthetic combined with epinephrine and sodium bicarbonate into tissue until it becomes firm and tense (tumescent). It was initially described in the field of liposuction but now surgical applications for the technique are widely varied ranging across vascular surgery, breast surgery, plastic surgery and ENT procedures. It is widely used in both hospital- and office-based environments and may form the sole method of anaesthesia for surgery. Advantages include a reduction in blood loss through both epinephrine-induced vasoconstriction as well as hydrostatic compression from the tumescent effect. Sodium bicarbonate reduces pain associated with the injection of an acidic local anaesthetic solution. Due to the unique pharmacokinetic profile of this technique lidocaine doses of 35 mg/kg bodyweight have been shown to be safe for liposuction procedures. Tumescent lidocaine is absorbed very slowly from subcutaneous tissues producing lower, and more delayed, peak blood levels compared to other routes, as well as extended postoperative analgesia. Slow systemic absorption allows the rapid hepatic plasma clearance of lidocaine to maintain safe local anaesthetic blood levels. This slow absorption from subcutaneous tissue has been likened to a depot injection. Careful attention must be given to appropriate local anaesthetic dosage alterations in cases of co-administration with agents affecting hepatic drug clearance or conditions reducing liver blood supply. Adherence to these pharmacological principles has produced an exemplary safety record for this technique to date.

The effect of high volume adrenalin solution infiltration on blood loss in reduction mammaplasty

“…These results indicate that increasing the adrenaline level in the tissue by increasing the amount of the fluid infiltrated does not increase the rates of complications. A decrease in the blood loss occurring with high volume fluid infiltration in reduction mammoplasty is ensured not only with an increase in vasoconstriction occurring in relation to an increase in the amount of adrenaline but also with high volume fluid pressure on the local blood vessels in the tissue [11]. However, there may be some disadvantages such as that the fluid in the tissue makes it difficult for electrocautery to work in resections performed especially with electrocautery and that the evaporation of the fluid in the tissue, secondarily to the temperature increase occurring with electrocautery, causes the excessive surgical smoke.…”

The Addition of Epinephrine to Proxymetacaine or Oxybuprocaine Solution Increases the Depth and Duration of Cutaneous Analgesia in Rats

“…Moreover, the rank of the nociceptive bock effect (AUCs) of combined drugs were epinephrine (1/2ED 50 ) with proxymetacaine (1/2ED 50 ) equal to epinephrine (1/2ED 50 ) with lidocaine (1/2ED 50 ) greater than epinephrine (1/2ED 50 ) with oxybuprocaine (1/2ED 50 ). Increasing evidence suggests that epinephrine, a vasoconstrictor, aids to prolong the duration of local anesthesia, 8 reduces the risk of toxicity, 28 restricts systemic absorption, 29,30 and reduces local blood flow. 31 Local anesthetics with epinephrine are infiltrated around a wound for several types of surgeries, or postoperative pain relief after inguinal hernia repair, 9 or laparoscopic surgery.…”

Textbook of Plastic and Reconstructive Surgery

“…Initially, it was indicated as a means of anaesthesia for liposuction procedures; however, its popularity has expanded into other surgical fields including breast, vascular, and ear, nose and throat surgery (Conroy and O'Rourke, 2013).…”

“…Tumescent anaesthesia, also known as the 'wet technique', describes the local infiltration of an extensive amount of solution containing a low concentration of local anaesthetic, adrenaline and sodium bicarbonate (Conroy and O'Rourke, 2013). Adrenaline provides the vasoconstriction required to reduce bleeding at the operative site, while sodium bicarbonate is added to neutralise the acidity of the local anaesthetic, mainly lidocaine, therefore reducing pain at the injection site.…”